Ethnic inequalities in Covid-19 vaccine uptake and comparison to seasonal Influenza vaccine uptake in Greater Manchester, UK: a cohort study

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Covid-19 vaccine uptake is lower amongst most minority ethnic groups compared to the White British group in England, despite higher Covid-19 mortality rates. Here, we add to existing evidence by estimating inequalities for 16 minority ethnic groups, examining ethnic inequalities within population subgroups, and comparing the magnitudes of ethnic inequalities in Covid-19 vaccine uptake to those in routine seasonal Influenza vaccine uptake.

Methods and Findings
We conducted a retrospective cohort study using the Greater Manchester Care Record (GMCR), which contains de-identified electronic health record data for the population of Greater Manchester, England. We used Cox proportional hazards models to estimate ethnic inequalities in time-to-Covid-19 vaccination amongst people eligible for vaccination on health or age (50+) criteria between 1st December 2020 and 18th April 2021 (138 days follow-up). We included vaccination with any approved Covid-19 vaccine, and analysed first-dose vaccination only. We compared inequalities between Covid-19 and Influenza vaccine uptake adjusting by age group and clinical risk, and used subgroup analysis to identify populations where inequalities were widest.

The majority of individuals (871,231 – 79.24%) were White British. The largest minority ethnic groups were Pakistani (50,268 – 4.75%), ‘any other White background’ (43,195 – 3.93%), ‘any other ethnic group’ (34,568 – 3.14%) and Black African (18,802 – 1.71%). 83.64% (919,636/1,099,503) of eligible individuals received a Covid-19 vaccine. Uptake was lower compared to White British for 15 of 16 minority ethnic groups, with particularly wide inequalities amongst ‘other Black background’ (HR 0.42 95%ci 0.40 to 0.44), Black African (HR 0.43 95%ci 0.42 to 0.44), Arab (HR 0.43 95%ci 0.40 to 0.48), and Black Caribbean (HR 0.43 95%ci 0.42 to 0.45) groups. 55.71% (419,314/752,715) of eligible individuals took up Influenza vaccination. Compared to the White British group, inequalities in Influenza vaccine uptake were widest amongst White and Black Caribbean (HR 0.63 95%ci 0.58 to 0.68) and White and Black African (HR 0.67 95%ci 0.63 to 0.72) groups. In contrast, uptake was slightly higher than White British amongst ‘other ethnic group’ (HR 1.11 95%ci 1.09 to 1.12) and Bangladeshi (HR 1.08 95%ci 1.05 to 1.11) groups.

Overall, ethnic inequalities in vaccine uptake were wider for Covid-19 than Influenza vaccination for 15 of 16 minority ethnic groups. Covid-19 vaccine uptake inequalities also existed amongst individuals who previously took up Influenza vaccination. Ethnic inequalities in Covid-19 vaccine uptake were concentrated amongst older and extremely clinically vulnerable adults, and the most income-deprived. A limitation of this study is the focus on uptake of first doses of Covid-19 vaccination, rather than full Covid-19 vaccination.

Ethnic inequalities in Covid-19 vaccine uptake exceeded Influenza vaccine inequalities, existed amongst those recently vaccinated against Influenza, and were widest amongst those with greatest Covid-19 risk. This suggests the Covid-19 vaccination programme has created additional and different inequalities beyond pre-existing health inequality. We suggest further research and policy action is needed to understand and remove barriers to vaccine uptake, and to build trust and confidence amongst minority ethnic communities.
Original languageEnglish
JournalPL o S Medicine
Publication statusAccepted/In press - 27 Jan 2022


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